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Background Air pollution and gestational diabetes mellitus (GDM) are both associated with increased diabetes mellitus (DM) occurrence. However, whether air pollutants modify the effects of GDM on the occurrence of DM has been unknown. This study aims to determine whether the effect of GDM on DM development can be modified by exposure to ambient air pollutants. Methods Women with one singleton birth delivery during 2004–14 according to the Taiwan Birth Certificate Database (TBCD) were included as the study cohort. Those newly diagnosed as having DM 1 year or later after childbirth were identified as DM cases. Controls were selected among women without DM diagnosis during follow-up. Personal residence was geocoded and linked with interpolated concentrations of air pollutants into township levels. Conditional logistic regression was used to determine the odds ratio (OR) of pollutant exposure and GDM, adjusting for age, smoking and meteorological variables. Results There were 9846 women who were newly diagnosed as having DM over a mean follow-up period of 10.2 years. We involved them and the 10-fold matching controls involved in our final analysis. The OR (odds ratio) (95% confidence interval, 95% CI) of DM occurrence per interquartile range increased in particulate matter (PM) smaller than or equal to 2.5 µm (PM2.5) and ozone (O3) was 1.31 (1.22–1.41) and 1.20 (1.16–1.25), respectively. The effects of PM exposure on DM development were significantly higher in the GDM group (OR: 2.46, 95% CI: 1.84–3.30) than in the non-GDM group (OR: 1.30, 95% CI: 1.21–1.40). Conclusions Exposure to high levels of PM2.5 and O3 elevates the risk of DM. GDM acted synergistically in DM development with exposure to PM2.5 but not with that to O3.

Background: The long-term effects of occupational injury (OI) on psychiatric diseases are unclear. This study assessed and compared the effects of OI, no injury (control), and non-OI (NOI) on the development of psychiatric diseases. Methods: We used Taiwan’s National Health Insurance Research Database to investigate the incidence of psychiatric disorders in OI, NOI, and control groups. The subjects were aged 20–50 years, actively employed in 2000, and did not have history of injury or psychiatric disorders. All subjects were followed from 2000 and were classified into OI, NOI, and control groups according to occurrence of target injury later on. Individuals in each group were matched by age, sex, insurance premium before the index date, and year of the index date. Psychiatric disease-free days were compared among the groups using survival analysis and Cox regression. Results: We included a total of 12,528 patients for final analysis, with 4,176 in each group. Compared with the control group, the OI group had an increased occurrence of trauma and stress-related disorder, depressive disorders, anxiety disorders, and alcohol and other substance dependence. These increases were similar to those in the NOI group. Elevated cumulative incidence rate of any psychiatric disorders was observed among those with OI or NOI up to 10 years after injury. Conclusion: We confirmed that OI and NOI induced psychiatric disorders. These findings highlight the need for workers’ compensation mechanisms to consider long-term psychological care among injured workers.

Metabolic syndrome (MetS), a major contributor to cardiovascular and metabolic diseases, has been linked with exposure to air pollution. However, the relationship between air pollutants and the five components of MetS [abdominal obesity, elevated triglyceride, decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, and elevated fasting blood glucose levels], has not been clearly described.We examined the association between long-term exposure to air pollutants and the occurrence of MetS and its components by using a longitudinal cohort in Taiwan.The MJ Health Research Foundation is a medical institute that conducts regular physical examinations. The development of MetS, based on a health examination and the medical history of an MJ cohort of 93,771 participants who were enrolled between 2006 and 2016 and had two or more examinations, was compared with estimated exposure to air pollutants in the year prior to health examination. The exposure levels to fine particulate matter [PM with an aerodynamic diameter ofDuring the average follow-up period of 3.4 y, the incidence of MetS was 38.1/1,000 person-years. After mutual adjustment and adjustments for potential covariates, the results indicated that everyOur findings suggest that in apparently healthy adults undergoing physical examination, exposure to

In hospitals, safety climate refers to the safety policies and regulations established by medical institutions and the measures taken to ensure medical personnel feel safe while working at these institutions. Safety climate can directly affect the overall work performance of medical personnel and indirectly affect patient care quality, which in turn impacts the rate of occupational hazards. Common occupational hazards in the medical workplace include contracting infectious diseases, overwork, irregular circadian rhythm due to working shifts, changes in sleep patterns and dietary habits, musculoskeletal discomfort, workplace violence, workplace stress, and needlestick injuries. This paper was developed to explore the history of promoting needlestick prevention in Taiwan, and discusses how to use the results of empirical research as scientific evidence and critical proofs to advocate for needlestick prevention and to establish related policies. In addition, the process of how improvements to the hospital safety climate and the prevention of occupational hazard incidents mutually influence and complement each other was examined. Future studies are encouraged to explore this topic to further elucidate the sources of workplace stress and to devise methods to ameliorate their influence on workplace stress in medical institutions. The results of these studies may be referenced by relevant government agencies and medical institutions when developing policies promoting safe environments in hospitals that improve the safe-work perceptions of nursing personnel and create comfortable and friendly medical environments.醫院安全風氣：由科學到政策—臺灣針扎防治歷程.醫療機構所建立相關的安全政策與制度，讓醫療人員感受到組織安全的相關作為，即是醫院安全風氣，其可以直接影響醫療人員整體工作表現，及間接地影響病人的照護品質，並進一步影響職業危害的發生狀況。醫療職場常見的職業危害，包含傳染性疾病、過勞高風險、輪班造成的晝夜節律、睡眠型態與飲食習慣改變、肌肉骨骼不適、職場暴力、職場壓力及針扎等；本文即是分享臺灣在針扎防治的推動歷程，如何運用實證研究結果的科學證據，倡議及提供政策制定的重要佐證及說帖，進而提升醫院安全風氣與職業危害事件降低之互相影響與改善的過程；未來應鼓勵透過更多的科學研究投入，針對職場壓力源的了解與改善，提供政府主管部門及醫療機構制定政策之參考，以創造安全風氣高的護理執業環境及提升護理人員對執業環境安全的整體知覺，共創合宜、友善的醫療執業環境。.

This study determined whether individuals residing near petrochemical industrial parks (PIPs) have a higher risk of chronic glomerulonephritis (CGN). We performed population-based 1:4 case-control study by using Taiwan's National Health Insurance Research Database from 2000 to 2016. The subjects were aged 20-65 years, residing in western Taiwan, and did not have a history of any renal or urinary system disease in 2000. The case cohort included those who had at least three outpatient visits or one hospitalization between 2001 and 2016 with codes for CGN as per International Classification of Diseases (ICD)-Ninth and Tenth Revisions. Controls were randomly sampled age-, sex-, and urbanization-matched individuals without renal and urinary system diseases. Petrochemical exposure was evaluated by the distance to the nearest PIP of the residential township, and petrochemical exposure probability was examined considering the monthly prevailing wind direction. Conditional logistic regression was used to determine the association between petrochemical exposure and CGN risk. A total of 320,935 subjects were included in the final analysis (64,187 cases and 256,748 controls). After adjustment for potential confounders, living in townships within a 3-km radius of PIPs was associated with a higher risk of CGN (adjusted odds ratio [aOR] = 1.32, 95% confidence interval [CI] = 1.28-1.37). Compared with townships more than 20 km away from PIPs, those within 10 km of PIPs were associated with significantly increased risks of CGN in a dose-dependent manner. When prevailing wind was considered, townships with high exposure probability were associated with a significantly increased risk of CGN. We found that those residing near PIPs or with high petrochemical exposure probability had a higher risk of CGN. These findings highlight the need for monitoring environmental nephrotoxic substances and the renal health of residents living near PIPs.

Evidence regarding the negative neurodevelopmental effects of compound exposure to petrochemicals remains limited. We aimed to evaluate the association between exposure to petrochemical facilities and generated emissions during early life and the risk of attention-deficit/hyperactivity disorder (ADHD) development in children. We conducted a population-based birth cohort study using the 2004 to 2014 Taiwanese Birth Certificate Database and verified diagnoses of ADHD using the National Health Insurance Database. The level of petrochemical exposure in each participant's residential township was evaluated using the following 3 measurements: distance to the nearest petrochemical industrial plant (PIP), petrochemical exposure probability (accounting for monthly prevailing wind measurements), and monthly benzene concentrations estimated using kriging-based land-use regression models. We applied Cox proportional hazard models to evaluate the association. During the study period, 48,854 out of 1,863,963 children were diagnosed as having ADHD. The results revealed that residents of townships in close proximity to PIPs (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.16-1.23,3 vs. ≥10 km), highly affected by petrochemical-containing prevailing winds (HR = 1.12, 95% CI: 1.08-1.16, ≥40% vs.10%), and with high benzene concentrations (HR = 1.26, 95% CI: 1.23-1.29, ≥0.75 vs.0.55 ppb) were consistently associated with the increased risk of ADHD development in children. The findings of the sensitivity analysis remained robust, particularly for the 2004 to 2009 birth cohort and for models accounting for a longer duration of postnatal exposure. This work provided clear evidence that living near petrochemical plants increases the risk of ADHD development in children. Further studies are warranted to confirm our findings.

Objective Short sleep duration is common among nurses. Sleep restriction has been associated with musculoskeletal discomfort. However, studies on the effect of short sleep duration on chronic neck and shoulder discomfort in nurses have been lacking. The aim of this study was to determine whether short sleep duration is related to chronic neck and shoulder discomfort. Methods We conducted a cross‐sectional survey of female nurses in secondary referral health centers in Taiwan. We applied stratified sampling based on region (north, central, south, and east) to select representative centers for this study. A self‐administered structured questionnaire, including demographic data, the psychological working environment, and musculoskeletal symptoms, was administered to nurses. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of average sleeping hours per working day on chronic neck and shoulder discomfort. Results A total of 1602 (78.9%) questionnaires were eligible for final analysis. The prevalence rates of chronic neck and shoulder discomfort were 33.9% and 34.7%, respectively. Population attributable risk estimation revealed that a sleep duration of

Loss of skeletal muscle mass is common with aging and can cause morbidity and mortality in the elderly. The effects of particulate air pollution on skeletal muscle mass is not known. The study aims to assess the chronic effects of ambient fine particulates (PM2.5) on the body composition of the elderly. From October 2015 to November 2016, a cross-sectional survey on 530 elderly (age > = 65 years) was conducted in the Taipei Basin, Taiwan. The body composition was measured by bioelectrical impedance analysis (InBody 120). One year exposure to air pollution was estimated using the Kriging method at the participant’s residence. Multiple linear regression analysis, after adjustments for demographics and co-pollutants, was used to examine the effects of PM2.5 on body composition indices and force of handgrip. Changes in body composition for an interquartile (1.4 μm/m3) increase in PM2.5 concentration included a 0.4 kg (95% confidence interval (CI): −0.31, −0.58; p 2.5 reduced fat free mass in the upper extremities and trunk, but not in the lower extremities, it increased body fat mass in the three parts. There was no significant effect of PM2.5 on handgrip force. Higher physical activity (versus lower than median) was associated with less detrimental effect of PM2.5 on skeletal muscle mass and body fat mass (p values for interaction term: 0.009 and 0.013, respectively). Long-term PM2.5 exposure is associated with decreased skeletal muscle mass and increased body fat mass in the elderly, which can be ameliorated by physical activity.

Background Living near petrochemical industries has been reported to increase the risks of adverse birth outcomes, such as low birth weight and preterm delivery. However, evidence regarding the role of petrochemical exposure in pregnancy complications remains limited. This study evaluated the association between maternal proximity to petrochemical industrial parks (PIPs) during pregnancy and the occurrence of premature rupture of membranes (PROM). Methods We performed a population-based 1:3 case–control study by using the 2004–2014 Taiwanese Birth Certificate Database. Birth records reported as stillbirth or bearing congenital anomalies were excluded. Cases were newborns reported to have PROM, whereas controls were randomly sampled from those without any pregnancy complications by matching birth year and urbanization index of the residential township. The proximity to PIPs was evaluated by calculating the distance to the nearest PIP of the maternal residential township during pregnancy. Furthermore, petrochemical exposure opportunity, accounting for monthly prevailing wind direction, was quantified during the entire gestational period. We applied conditional logistic regression models to evaluate the associations. Results In total, 29371 PROM cases were reported during the study period, with a corresponding 88113 healthy controls sampled. The results revealed that living within a 3-km radius of PIPs during pregnancy would increase the risk of PROM (odds ratio [OR] = 1.76, 95% CI: 1.66–1.87). Furthermore, compared with the lowest exposed group, those with high petrochemical exposure opportunity had a significantly increased risk of PROM occurrence (OR = 1.69–1.75). The adverse effects remained robust in the subgroup analysis for both term- and preterm-PROM. Conclusions The results of the present work provide evidence that living near PIPs during pregnancy would increase the risk of PROM, and additional studies are warranted to confirm our findings.

Purpose Nurses are exposed to a poor psychological work environment; this may cause poor mental health, which is a risk factor for suicidal ideation. We investigated the association between psychological work environment and suicidal ideation among hospital nurses in Taiwan. Design We conducted a cross-sectional survey in Taiwan female nurses using stratified sampling by region (north, central, south, and east) to select representative centers for this study. Methods A self-report questionnaire including items on demographic data, the psychological work environment, and suicidal ideation was sent to nurses working in hospitals. Multiple logistic regression and population attributable risk analyses were performed to assess the effect of the psychological work environment on suicidal ideation. Findings A total of 2,734 eligible questionnaires (76.8%) were returned. The prevalence of suicidal ideation was 18.3%, and higher risk was found to be associated with the educational level of junior college or below, higher personal burnout, higher client-related burnout, and always feeling stressed at work. Estimation of population attributable risk showed that higher personal burnout, client-related burnout, and always feeling stressed at work were the most crucial factors among nurses, accounting for 19.4%, 8.6%, and 10.5% of suicidal ideation, respectively. Conclusions A considerable proportion of nurses developed suicidal ideation. A poor psychological work environment was a relevant factor for suicidal ideation. Clinical evidence This study provides relevant knowledge for nursing management levels in preventing the development of suicidal ideation among nurses. Not only for nurses' mental health, but for patient safety and care quality, further studies in improving nurses' psychological work environment are warranted.

Occupational injuries have considerable impact on workers’ lives. However, data regarding workers’ health-related quality of life (HRQOL) at several years after the injury are lacking. This study assessed workers’ HRQOL at 6 years after occupational injury and determined related factors in each HRQOL domain. Workers who sustained an occupational injury in 2009 and who responded to a previous survey at 3 or 12 months after their injury were followed up in 2015. A total of 1715 participants were candidates for this study. The Taiwanese version of the World Health Organization Quality of Life scale-abbreviated version (WHOQOL-BREF) was used to assess their HRQOL. Multiple linear regression analysis identified predictive factors for HRQOL at 6 years after occupational injury. A total of 563 workers completed the questionnaire (response rate, 32.8%). Adverse life events and additional severe occupational injuries that occurred within the follow-up period, and decreased salary after the injury were significant factors for low scores in all domains of the WHOQOL-BREF. In addition, unmarried participants had low scores in the social relationship domain. Workers with family members requiring care scored low in the physical and environment domains. Workers whose injuries had major effects on their physical appearance had low scores in the physical and psychological domains. Workers with unstable employment had low scores in physical, psychological, and environment domains. At 6 years after occupational injury, workers’ HRQOL was poor among those whose salaries decreased after the injury, after adjustment for other factors.

Background: Poor psychosocial work environments are considered critical factors of nurses’ intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses’ intention to leave their profession and the population attributable risk among nurses. Objective: This study identified factors associated with workplace justice and nurses’ intention to leave the profession. Method: A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses’ intention to leave the nursing profession. Ethical considerations: This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. Result: A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02–1.77). “Employees’ opinions are influential in hospital’s decision making” and “employees’ performance is evaluated fairly” were the most influential factors of the participants’ intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. Conclusion: This study has identified that workplace justice is a protective factor of nurses’ leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

The aim of this study is to determine the prevalence rates of depressive, anxiety and PTSDs, and the risk factors for psychological symptoms at 6 years after occupational injury. This longitudinal study followed workers who were occupationally injured in 2009. Psychological symptoms and return to work were assessed at 3 and 12 months after injury. Injured workers who had completed the initial questionnaire survey at 3 or 12 months after injury were recruited. A self-administered questionnaire was mailed to the participants. For workers with high Brief Symptom Rating Scale and Post-traumatic Symptom Checklist scores, an in-depth psychiatric evaluation was performed using the Mini-international Neuropsychiatric Interview. A total of 570 workers completed the questionnaire (response rate, 28.7%). Among them, 243 (42.6%) had high psychological symptom scores and were invited for a phone interview; 135 (55.6%) completed the interview. The estimated rates of major depression and post-traumatic stress disorder (PTSD)/partial PTSD were 9.2 and 7.2%, respectively, and both these rates were higher at 6 years after injury than at 12 months after injury (2.0 and 5.1%). After adjustment for family and social factors, the risk factors for high psychological scores were length of hospitalization immediately after injury, affected physical appearance, repeated occupational injuries, unemployment, and number of quit jobs after the injury. At 6 years after occupational injury, the re-emergence of psychiatric disorders was observed. Relevant factors for poor psychological health were severity of injury and instability of work. Periodic monitoring of psychological and physical health and economic stability are warranted.

We present a holistic machine-learning framework for rapid screening of bimetallic catalysts with the aid of the descriptor-based kinetic analysis. A catalyst database, which contains the adsorption energies of *CO and *OH on {111}-terminated model alloy surfaces and fingerprint features of active sites from density functional theory calculations with the semi-local generalized gradient approximation (GGA), is established and used in optimizing the structural and weight parameters of artificial neural networks. The fingerprint descriptors, rooted at the d-band chemisorption theory and its recent developments, include the sp-band and d-band characteristics of an adsorption site together with tabulated properties of host-metal atoms. Using methanol electro-oxidation as the model reaction, the machine-learning model trained with the existing dataset of ∼1000 idealized alloy surfaces can capture complex, non-linear adsorbate/metal interactions with the RMSE ∼ 0.2 eV and shows predictive power in exploring the immense chemical space of bimetallic catalysts. Feature importance analysis sheds light on the underlying factors that govern the adsorbate/metal interactions and provides the physical origin of bimetallics in breaking energy-scaling constraints of *CO and *OH, the two most commonly used reactivity descriptors in heterogeneous catalysis.

Background Ambient nitrogen dioxide is associated with asthma occurrence in adults in Western countries. However, two recent large-scale studies have provided inconclusive results regarding this association. Moreover, the association remains unknown in an Asian population. Objective We aimed to investigate the association between ambient air pollution exposure and incident adult asthma. Methods From 2016 to 2017, we conducted a cross-sectional self-administered questionnaire survey with retrospective follow-up of incident asthma cases among schoolchildren's parents from 41 schools within 1 km of air monitoring stations distributed throughout the main island of Taiwan. To estimate participants' exposure, air pollution data of air monitoring stations within 1 km of schools from where participants were sampled were inputted into the proximity model. We used mixed logistic regression models to determine the association between air pollution exposure and asthma onset within five years prior to the survey. Results The questionnaire was completed for a total of 11 585 participants out of 13 424 candidates (response rate, 86.3%). Among 9131 participants aged from 26 to 50 years, 101 were diagnosed with asthma within the five years prior to the survey. The prevalence of incident asthma cases was 2.2 per 1000 person-years. Those exposed to higher ambient nitrogen dioxide (odds ratio = 1.20 per interquartile [5.7 ppb] of nitrogen dioxide, 95% CI = 1.02–1.42) were more likely to develop adult-onset asthma. Conclusion In an Asian population, exposure to higher ambient nitrogen dioxide is associated with increased prevalence of incident asthma cases among adults aged 26–50 years.

Loss of skeletal muscle mass is common with aging and can cause morbidity and mortality in the elderly. The effects of particulate air pollution on skeletal muscle mass is not known. The study aims to assess the chronic effects of ambient fine particulates (PM2.5) on the body composition of the elderly. From October 2015 to November 2016, a cross-sectional survey on 530 elderly (age > = 65 years) was conducted in the Taipei Basin, Taiwan. The body composition was measured by bioelectrical impedance analysis (InBody 120). One year exposure to air pollution was estimated using the Kriging method at the participant’s residence. Multiple linear regression analysis, after adjustments for demographics and co-pollutants, was used to examine the effects of PM2.5 on body composition indices and force of handgrip. Changes in body composition for an interquartile (1.4 μm/m3) increase in PM2.5 concentration included a 0.4 kg (95% confidence interval (CI): −0.31, −0.58; p

Psychological factors may compromise return to work among workers with occupational injuries, and little is known about the long-term consequences of psychological symptoms relating to return to work. The study examined the impact of psychological symptoms on return to work as well as exploring factors associated with return to work among injured workers. A total of 572 workers who experienced occupational injuries were recruited in this prospective cohort study. Surveys of the psychological symptoms using the 5-item Brief Symptom Rating Scale (BSRS-5) were conducted at 3 and 12 months after the injury. All of the workers were invited to join the study at year 6 after the injury. Sociodemographic factors, psychological symptoms, injury severity, and return-to-work status were collected. Approximately 10% of injured workers could not return to work even 6 years after the injury. Severe psychological symptoms within 1 year after the injury presented a significant risk factor for not returning to work 6 years after the injury (adjusted OR = 0.7, 95% CI: 0.5–0.8). Furthermore, age, education level, length of hospitalization, and injury-induced changes in appearance had significant independent influence on return to work as well. These findings highlight the importance of the effects of mental health within 1 year post injury on return to work, and support the concept of early screening, detection, and intervention in at-risk occupational injured workers with severe psychological symptoms.

Background Exposure to air pollution has been linked to adverse effects on vascular diseases. However, the effects of air pollution exposure on diabetic retinopathy (DR), a vascular disease, have not been studied. Objective To determine the association of ambient air pollution exposure with DR risk. Methods Patients newly diagnosed as having diabetes mellitus (DM) during 2003–2012 from Longitudinal Health Insurance Database 2005), a subset of National Health Insurance Research Database, were included as the study cohort. Newly diagnosed DR patients one year or later after DM diagnosis were identified as cases. Kriging was used to interpolate yearly concentrations of air pollutants at township levels and linked with every individual's residence in each year; average concentrations during the follow-up period were then calculated as personal exposure. Conditional logistic regressions with adjustments for age at DM diagnosis and comorbidities were applied. Results Of newly diagnosed DM cases during 2003–2012, 579 were newly diagnosed as having DR over a mean follow-up period of 5.6 years. The Odds ratio (95% confidence interval) of DR occurrence for every 10-μg/m3 increase in particulate matter with ≤2.5 and 2.5–10-μm diameter was 1.29 (1.11–1.50) and 1.37 (1.17–1.61), respectively. Conclusion In patients with DM, the higher particulate matter exposure, the higher is the DR risk.

Background: Injuries are known to be a relevant risk factor for psychiatric disorders. Psychiatric disorders were found increased after occupational injury, and such increase was observed up to six...

Molecular functionalization of porphyrins opens countless new opportunities in tailoring their physicochemical properties for light-harvesting applications. However, the immense materials space spanned by a vast number of substituent ligands and chelating metal ions prohibits high-throughput screening of combinatorial libraries. In this work, machine-learning algorithms equipped with the domain knowledge of chemical graph theory were employed for predicting the energy gaps of12 000 porphyrins from the Computational Materials Repository. Among a variety of graph-based molecular descriptors, the electrotopological-state index, which encodes electronic and topological structure information, captures the energy gaps of porphyrins with a prediction RMSE0.06 eV. Importantly, feature sensitivity analysis suggests that the carbon structural motif in methine bridges connected to the anchor group predominantly influences the energy gaps of porphyrins, consistent with the spatial distribution of their frontier molecular orbitals from quantum-chemical calculations.

Introduction Annually in the world, more than 300 million nonfatal occupational accidents occur requiring at least 4 days of absence from work. Elevated psychiatric disorders and psychological symptoms are reported after occupational injuries. In addition, those with poorer psychological conditions had lower probability of returning to work, and those who with a disability of the upper or lower extremity tended to have higher mortality from self-harm in later life than did the general population. In cases of severe injury, a proportion of workers spent the rest of their life suffering from psychological ailments. Methods Using the available information on incidence rates of occupational injuries, and related psychological and psychiatric ailments after occupational injuries, overall psychosocial impacts as a result of occupational injuries are estimated, including psychiatric diseases, psychological symptoms, disability from work, and suicides. Result Psychiatric diseases worldwide are caused directly or indirectly by occupational injuries. The less severe forms of mental consequences are psychological symptoms or preclinical psychiatric conditions. Significant percentage of permanent disabilities are caused by psychiatric conditions related to injuries. In addition, delayed return-to-work, i.e., longer duration of temporary disability is found among injured workers with psychological symptoms. A special form of psychological/psychiatric condition, suicides and suicidal ideation are increased among injured workers. There are still limitations in this analysis due to a great varieties of psychological outcomes obtained, and to lacking of epidemiological assessment of these conditions after occupational injuries. Discussion Generally, the psychosocial impacts of occupational injuries are greater than generally understood. In addition to preventing occupational injuries, secondary and tertiary prevention to minimise psychosocial impacts are warranted.

No study has examined the effects of air pollutants on albuminuria in type 2 diabetes. Therefore, the present study investigated this association.This follow-up study enrolled 812 patients with type 2 diabetes between 2003 and 2012. The urinary albumin-to-creatinine ratio (ACR) was recorded annually. Exposure to the air pollutants CO, NOThe study objects (mean age: 55.4 years) were followed for 3 or more years (average period: 5.4 years). ACR increase was found to be positively associated with the male sex, baseline hemoglobin A1c, and exposure to CO and PMExposure to high CO and PM

Lack of sleep is a common problem amongst nurses. Short sleep duration has been related to stress and burnout. However, in nurses, the effects of short sleep duration on job strain and burnout are controversial and a clear relationship has been lacking. This study aims to assess whether short sleep duration is related to job strain and burnout statue, and whether such relationship is in a dose-dependent manner.A cross-sectional survey among female nurses in secondary referral health centers in Taiwan, using a self-administered structured questionnaire. Stratified sampling by region and patient bed number category was done to select representative centers for this survey. Approximately 10% of all secondary referral centers were randomly selected from each stratum. Non-linear dose-response relationship between sleep duration and job strain and burnout scores was assessed by general additive models (GAM), adjusting for personal characteristics, work condition, and family situation.Among the 2268 full-time nurses in 39 hospitals invited to participate in this study, 1384 (61%) satisfactorily completed the questionnaire. There were 169 nurses (12.2%) who slept less than 6 h per working day. Among the participants, 37% (n=512) were classified into high strain group. The mean scores of personal, work-related, and client-related burnout were 59.4 (SD=22.0), 54.6 (SD=21.7), and 42.3 (SD=18.6). Compared to those slept longer than 7 h, nurse who slept less than 6 h per working day had higher risk for job strain (adjusted odds ratio, AOR=1.8, 95% confidence interval, CI=1.2-2.7), personal burnout (AOR=3.0, CI=1.7-5.2), work-related burnout (AOR=3.4, CI=2.0-6.0), and client-related burnout (AOR=2.0, CI=1.2-3.6). GAM analysis found a linear relationship between sleep duration and job strain, and client-related burnout. For personal and work-related burnout, a linear increase in burnout score between 7 h and 5 h of sleep was observed, followed by a leveling off for durations of less than 5 h.Our study found sleep duration at working days was inversely associated with female nurses' job strain and burnout in a dose-dependent manner. Further studies on work factors which affecting sleep duration are warranted.

Background Exposure to high temperature has been linked to adverse effects including cardiovascular and renal functions. It was also proposed to diminish human performance capacity and increase accident risk. However, the effects of high temperature on occupational injury have not been extensively studied. Objective The aim of this study was to determine the association between ambient temperature and occupational injury (OI) occurrence. Material and Methods OI information was extracted from the National Health Insurance Research Database (NHIRD). Daily ambient temperature and relative humidity (RH) were obtained from the Taiwan EPA air monitoring station. The day of first time OI outpatient/emergency visits during 2006–2011 was used as the event day. The same weekdays of the month were used as the referent day. Time-stratified case-crossover design and conditional logistic regression was used to investigate the relationship between ambient temperature and OI outpatient visits, adjusting for RH. Results There were 18 951 first time OI outpatient/emergency visits during 2006–2011. The odds ratio (OR) of OI outpatient visits associated with per interquartile range (7.7 degree centigrade) increase in ambient temperature of the same day (lag 0 day) was 1.15 (95% confidence interval, CI: 1.08–1.22). The ORs associated with lag1 (the day before visit day) to lag3 day was 1.13 (95% CI: 1.06–1.19), 1.11 (95% CI: 1.04–1.17), and 1.11 (95% CI: 1.02–1.14), respectively. Conclusion Exposure to higher ambient temperature was associated with increased risk of OI outpatient visits.

Background Certain proportion of workers developed psychological symptoms within 1 year after occupational injury. Mental health is associated with overall health status. However, few studies examined the effect of psychological symptoms after occupational injury on long­-term health status. This study aims to determine the impact of psychological symptoms within 1 year after occupational injury on health status six years later. Method 2308 workers who sustained an occupational injury in 2009 and responded to a survey at 3 or 12 months after their injury were followed up in 2015. At 6 years after the injury, they were invited to participate in a questionnaire survey, which included return-to-work condition and self-rated health status.Population attributable risks (PARs) were estimated to assess the effect of psychological symptom on self-­rated poor health. Results A total of 570 workers (33.5%) completed the questionnaire. Injured workers who had adverse life event within follow-up period, had family member requiring care, did not return-to-work within 1 year after the injury, had severe psychological symptom within 1 year after the injury, and whose physical appearance was severely affected had a higher risk of self-rated poor health. Adverse life event within follow-up period was most important factor, accounting for 34.3% of self-perceived poor health, followed by severe psychological symptom within 1 year after the injury (15.0%), and severely affected physical appearance (11.7%). Conclusion Injury severity and severe psychological symptoms after occupational injury were risk factors for poor health status. Interventions addressing these factors are warranted to reduce psychological ailments after occupational injury.

Background Nurses are exposed to poor psychological work environment which in turn may cause poor mental health. Poor mental health is a risk factor for suicidal ideation. We intended to understand the association between psychosocial work environment and suicidal ideation among hospital nurses in Taiwan. Method A self-reported questionnaire including demographic data, psychological work environment, and the question of suicidal ideation was sent to our participants- female nurses working in hospitals. Multiple logistic regression and population attributable risks (PARs) were preformed to assess the effect of psychological work environment on reporting having suicidal ideation. Results A total of 2492 (72.6%) returned the questionnaires and were eligible for final analysis. The prevalence of reporting suicidal ideation was 18.3%. Higher risk of suicidal ideation was found associated with age between 36 and 40, educational level of Junior college or below, working for more than 60 hours per week, higher personal burnout, higher client-related burnout, and always felt stressed at job. Estimation of PAR showed that higher personal and client-related burnout, and always felt stressed at job were the most crucial factors and accounted for 12.2%, 9.3%, and 7.7% suicidal ideation among nurses. Conclusion A significant proportion of nurses developed suicidal ideations. Poor psychological work environment and long working hours were relevant factors for suicidal ideation. A good psychological work environment is warranted to dissuade nurses from developing suicidal ideations.

Objective 1) To estimate the prevalence of insufficient sleep and poor sleep quality by different shiftwork status in a representative sample of the Taiwan working population. 2) To estimate PARs of sleep-related problems as related to shiftwork. Methods The data of 22 600 workers aged 20 to 65 years were retrieved from the Survey of Perceptions of Safety and Health in the Work Environment, a nationwide cross-sectional survey conducted in 2010. Insufficient sleep was defined as self-reported short sleep duration interfering with life or work activity. Sleep quality was categorised into very good, good, poor and very poor. Work shifts were classified into fixed daytime, evening, or night, rotating night shift, rotating shift not including night, and irregular. Multivariate logistic regression was used to calculate the ORs and then estimated PARs of sleep-related problems. Results Among all workers, shift status were as follows: fixed daytime shift 74.7%, fixed evening 10.6%, fixed night 2.3%, rotating night shift 5.3%, rotating shift not including night 2.0%, and irregular 5.2%. The highest prevalence of sleep-related problems was observed among fixed night workers with insufficient sleep of 12.1% and poor sleep quality 3.5%. Fixed night shift was associated with the highest risk of both insufficient sleep (OR=3.20, 95% CI 2.41–4.18, p Conclusions Night shiftwork was significantly associated with increased risk of insufficient sleep and poor sleep quality among Taiwanese workers.

Introduction This study aimed to examine the prevalence rates of psychological symptoms and risk factors between female and male workers at 12 months after their sustaining occupational injurie. Demographic and injury-related risk factors for psychological symptoms were evaluated. Methods Our study candidates were injured workers in Taiwan who were hospitalised for 3 days or longer and received hospitalisation benefits from the Labour Insurance program. A self-reported questionnaire including the Brief Symptom Rating Scale was sent to workers at 12 months after injury. Results A total of 1233 workers (response rate 28.0%) completed the questionnaire, including 356 women and 877 men. A higher percentage (30.1%) of women had elevated BSRS-5 score of 6 or higher than men (22.5%). The risk factors for elevated psychological symptom scores for female workers were lower education level (odds ratio, OR=1.8, 95% confidence interval, CI=1.1–3.0), main income contributor of the household (OR=1.8, CI=1.1–3.0), severely affected physical appearance due to injury (OR=2.8, CI=1.3–5.9), and having adverse life event after injury (OR=2.0, CI=1.1–3.6) after mutual adjustment. Whereas the risk factors for elevated psychological symptom scores for female workers were loss of consciousness after the injury (OR=2.0, CI=1.3–3.1), severely affected physical appearance due to injury (OR=3.7, CI=2.3–6.0), having adverse life event after injury (OR=2.5, CI=1.6–3.8), not return-to-work (OR=3.2, CI=2.0–5.1), and reduced salary as compared to that before injury (OR=2.4, CI=1.3–4.1). Conclusions After occupational injury, women suffered from higher rate of psychological symptoms. Risk factors were different between men and women who sustained occupational injuries.

Objective Suicide attempts can result from traumatic events, including those caused by occupational injury. However, literature on the long-term prevalence rates of suicidality after occupational injury is relatively lacking. This study investigated the long-term prevalence of suicidality after occupational injury. Methods Between February 1 and August 31, 2009, 4,403 workers in Taiwan sustained occupational injuries and were hospitalized for 3 days or longer. Surveys were conducted at 3 and 12 months after occupational injury, and 2,308 workers responded to either survey. They were invited to join the follow-up at 6 years after occupational injury, using the Brief Symptom Rating Scale (BSRS-5), Posttraumatic Symptom Checklist (PTSC), and 1 question on suicidal ideation. Workers with a high score on the BSRS-5 or PTSC were invited to participate in an in-depth psychiatric evaluation using the Chinese version of the Mini-International Neuropsychiatric Interview (MINI). Results The estimated MINI-diagnosed suicidality rates at 3 months, 12 months, and 6 years after occupational injury were 5.4%, 4.8%, and 9.5%, respectively. Injured workers who reported that the injury majorly affected their physical appearance, experienced additional occupational injury requiring hospitalization for > 3 days, had unstable employment, and had lower income in the past 1 year than that before occupational injury had a higher risk of suicidal ideation. Injury majorly affecting the physical appearance, unstable employment, and lower income than that before occupational injury were the most crucial factors. These factors accounted for 12.7%, 13.2%, and 19.0% of suicidal ideation among the injured workers. Conclusions The suicidality rate increased at 6 years after occupational injury. The relevant factors for suicidal ideation were injury severity and work instability. Periodic monitoring of psychological and physical health and economic stability are warranted.

In healthcare settings, nurses&rsquo, workload, burnout, and job satisfaction are associated to the patient&ndash, nurse ratio. Whether this ratio also affects their intention to leave the nursing profession, along with the underlying stress pathway, remains unclear. This study aimed to investigate the effects of the patient&ndash, nurse ratio on nurses&rsquo, intention to leave and considering the mediating roles of burnout and job dissatisfaction. The study analyzed the data of two pooled cross-sectional surveys collected in 2013 and 2014. Measures were obtained by a structure questionnaire, which queried the average daily patient&ndash, nurse ratio (ADPNR), nurses&rsquo, personal burnout, client-related burnout, job dissatisfaction, intention to leave, and other demographics. ADPNRs were standardized according to hospital levels. Multiple regression models examined mediation hypotheses, and a percentile bootstrap confidence interval was applied to determine the significance of indirect effects. A total of 1409 full-time registered nurses in medical and surgical wards of 24 secondary or tertiary hospitals in Taiwan completed self-administered questionnaires. Most of the participants were female (97.2%), and the mean age was 29.9 years. The association between the standardized ADPNR and intention to leave their job was significantly mediated by personal burnout, client-related burnout, and job dissatisfaction. Higher standardized ADPNRs predicted higher levels of personal burnout, client-related burnout, and job dissatisfaction, each of which resulted in higher levels of intention to leave the current job. The results highlight that appropriate patient&ndash, nurse ratio standards may be further discussed by selecting personal burnout, client-related burnout, and job dissatisfaction as indicators.

Background Suicidal attempt has been reported as a consequence after experiencing a traumatic event, including that caused by occupationally injury. However, literature is relatively lacking in long-term prevalence rates of suicidality after occupational injury. Objective To determine long-term prevalence of suicidality after occupational injury. Method Form February to August, 2009, 4,403 workers sustained occupational injury, and were hospitalised for 3 days or longer. Two surveys on psychiatric conditions were done at 3 and 12 months after occupational injury, and 2,308 workers responded to either survey. They were invited to join the follow-up at 6 years after occupational injury. A self-reported questionnaire survey was conducted, including Brief Symptom Rating Scale (BSRS) and Post-traumatic Symptom Checklist (PTSC) for assessment of psychological symptom. Those with high scores in BSRS or PTSC were invited to participate in an in-depth psychiatric evaluation using Chinese version of the Mini-international Neuropsychiatric Interview (MINI). Results At three months, one year, and six years, 2001, 1233, and 570 workers completed the questionnaire, and among those with severe psychological symptoms by BSRS and PTSC, 41.5%, 63.5%, 55.6% completed the phone interview. The estimated rates of suicidality at 3, 12 months, and 6 years after occupational injury were 4.9%, 4.3%, and 9.8% respectively. Conclusion Contradictory to general belief, suicidality rate was increasing at 6 years after occupational injury. Further studies to identify the causes of increased suicidality at later years, and develop strategies to improve injured workers’ psychological health are warranted.

Objectives To assess job strain and burnout status among female nurses working in primary clinics, secondary referral hospitals, and public health units in Taiwan. Method Study participants included female nurses from (1) all primary clinics (PC) hiring more than two registered nurses; (2) a nation-wide representative sample of secondary referral hospitals (SRH), selected using stratified random sampling; and (3) all public health units (PHU) hiring more than two registered nurses. To candidate participants, a structured, self-administered questionnaire was disseminated, which included demographic information, work conditions, the Chinese Job Content Questionnaire, and the modified Chinese Copenhagen Burnout Inventory. Results A total of 6087 questionnaires were sent, and 4046 (66.5%) were satisfactorily completed. Compared with PC nurses, nurses working in SRHs and PHUs had higher job strain (adjusted odds ratio, aOR=1.7, 95% confidence interval, CI=1.3–2.1 for SRH; aOR=2.4, 95% CI=1.7–3.4 for PHU), personal burnout (aOR=2.6, 95% CI=1.8–3.6 for SRH; aOR=3.4, 95% CI=2.1–5.7 for PHU), work-related burnout (aOR=2.4, 95% CI=1.8–3.1 for SRH; aOR=3.0, 95% CI=2.0–4.5 for PHU), and client-related burnout (aOR=1.6, 95% CI=1.2–2.3 for SRH; aOR= 2.1, 95% CI=1.2–3.5 for PHU) while adjusted for significant variables. Conclusions We concluded that nurses worked in public health units and secondary referral hospitals had higher job strain and work-related burnout as compared to primary clinics. Further study should examine the stressors from these workplaces and follow up the health effects of high strain and burnout status.

Objectives This study aims to explore the psychosocial impacts of health care workers (HCW) who were exposed to a contaminated needlestick Injury (NSI) or blood and body fluid (BBF) at work. Method Personal interviews were performed using a phenomenological approach including in-depth interviews fort data collection, and expert meetings for data analysis. The trustworthiness of the study was examined using Lincoln and Guba (1985) principles. Results Seventeen health care workers participated in our study. There are five main themes generated, including (1) Emotional loading: shock and collapse, fear of being seroconverted to infectious diseases, worry about family members, and damage of the professional image. (2) Disappointment on the working environment: lack of manpower support, feel isolated and helpless. (3) Disapproving eyes: invasion of privacy, fear of being labelled. (4) Impact on life: feelings of life-threatening, prophylaxis of physical discomfort, impact on professional ambitions. (5) Self-adjustment: efforts to recover from the event. Conclusions A needlestick injury not only causes risk of infection, but has great psychosocial impact to the victims. Intervention should cover psychosocial support to the health care workers in addition to prophylaxis of infection.

Objective The aim of this study was to determine whether the frequency of changing work shift and overtime are associated with registered nurses’ menstrual characteristics. Method Female nursing staff aged 20–45 years and working at hospitals were invited to participate in the study. Menstrual characteristics and work shifts were recorded daily for 180 days. A multivariate logistic model was performed. Important confounders such as age, educational level, occupational category, regular excise habit, and major earner of family were adjusted. Result A total of 330 nurses and 1,437 menstrual cycles were collected and eligible for the final analysis. The adjusted odds ratio for shorter bleeding time (≦3 days) was associated with changing work shift (involved one night shift) more than 3 times between menstrual cycles were 2.2 (95% CI = 1.1–4.3). The adjusted odds ratios for longer menstrual cycle lengths (>40days) due to changing work shift (involved one night shift) more than 3 times between menstrual cycles were 4.7(95% CI = 3.1–7.1). The adjusted odds ratios for dysmenorrhea due to overtime more than 40 hours during 28 days before menstrual were 2.9 (95% CI = 1.6–5.2). Conclusion The high frequency of changing work shift (esp. from day shift change to night shift or from evening shift to night shift) and overtime (>40 hours/ 28days) may affect childbearing aged female nurses’ reproductive function.

Objectives The aim of this study was to determine whether sleeping time of working days and the percentage of night shift are associated with nurses9 job strain and burnout. Methods We recruited female nursing staff from district hospitals in Taiwan. We obtained demographic information, working conditions, job content questionnaire (JCQ), and Copenhagen Burnout Inventory (CBI) using a self-administered questionnaire, focusing on job strain, personal or generic burnout, work-related burnout, and client-related burnout. A multivariate logistic model was performed. Important confounders such as age, educational level, occupational category, regular excise habit, and major earner of family were adjusted. Results A total of 1235 nurses responded satisfactorily and were eligible for the final analysis. The adjusted OR for high strain was associated with sleeping ≤5 h per working day and percentage of night shift in last year 10% were 1.59 (95% CI 1.05 to 2.39) and 1.32 (95% CI 1.02 to 1.70). The adjusted OR for high personal or generic burnout due to sleeping ≤5 h per working day was 2.37 (95% CI 1.09 to 6.23). The adjusted OR for high client burnout due to sleeping ≤5 h per working day was 1.86 (95% CI 1.16 to 3.08). Conclusions This study identifies associations between shorter sleeping h per working day and higher percentage of night shift in last year. In addition, only shorter sleeping time per working day is associated with personal or generic burnout and client-related burnout. Further investigation on how the working conditions of nurses could be improved is warranted.